RESPIRATORY SUPPORT

1. Oxygen therapy

2. Mechanical stimulator

3. Nasal CPAP / SIMV-CPAP

4. BI-PAP

5. Mechanical ventilation

Respiratory Assessment

• Is the patient Ventilating well? >>> Normal PCO2

– Normal ventilatory effort– Increase work of breathing

• Able to compensate

• Is patient getting exhausted >> Impending respiratory failure

• Is the patient oxygenating well? >> Normal Pa O2

– Assess oxygen requirement– A-a gradient Vs PaO2/FiO2 >> Hypoxic respiratory

failure?

Respiratory Assessment

1. Mental Status (Is patient being sedated)2. RR (according to age)3. Work of breathing (retraction, nasal flaring,

paradoxic breathing)4. Chest movement-Air-entry5. Adventitious sounds (Stridor-wheezes,

crackles)6. Oxygen requirements7. Cardiovascular status, (Compensatory

mechanisms: HR, BP, perfusion)8. Peak Flow9. ABG

Respiratory Mechanics

• Flow

• Compliance (degree of stiffness)

Compliance = Volume

Pressure

• Resistance = = Pressure

Flow

• Time Constance

ARF

In the absence of intracardiac shunt.

• Pa02 < 50 mm Hg

• PC02 > 50 mmHg

• Increase PaO2/Fio2 < 200 (Normal >400)

• Increase A-a gradient (>300)

(PaO2 60 on FiO2 of 0.6 = 100)

Indication for Intubation

• For Airway protection– Facial Trauma– Alter mental status– Recurrent Apnea

• Respiratory Failure– Hypoventilatory– Hypoxic– Mix

• Cardiovascular instability- Shock

1. Alter sensorium / Coma2. Inability to speak3. Increasing pulsus paradosus4. Signs of exhautioon (decreasing pulsus paradosus5. Respiratory or cardiac arrest6. Diaphoresis in the recumbent position7. Acute Barotrauma8. Severe Lactic Acidosis (specially in infants)9. Silent chest despite respiratory effort10.Refractory hypoxemia (PaO2 < 60 mmHg on maximal

O2)11. Increasing PaCO2 (50 mmHg and rising > 5 mmHg/hr)

INDICATION FOR INTUBATION AND MECHANICAL VENTILATION IN STATUS ASTHMATICUS

General Principles Approaches to Lung Protection

• Small tidal volumes/pressure limitation– Prevent Barotrauma– Prevent Volutrauma

• Recruitment maneuvers, with – Higher PEEP levels– Ventilation in the prone position

OXYGEN THERAPY“Low Flow Oxygen < 35 %”

Nasal Cannula: No more than 3L/minEach L/min delivers ~ 4 % Oxygen > RAAt low flows, no need to humidify

Simple MaskUse for an emergency/ transport Deliver ~ 30% at 6-8 L/min

OXYGEN THERAPY“Moderate Amount= >35% < 50%)

VENTURY MAST: 28% TO 50 %

AEROSOLIZED MASK

25% TO 100%

Oxygen Delivery High Flow

Non re-breathing mask •high flow delivered system with reservoir, • It deliver between 80 to 100% FiO2. • This delivering System is use mainly for transport and for initially emergency care and patient stabilization.

OXYHOOD25 % TO 100%

NASAL cpap

NON INVASIVE VENTILATION

BI-PAP

HOW TO ORDER MECHANICAL STIMULATOR(Pt with recurrent apnea, in between O2 Sat 100% in RA)1) Under order entry, SELECT Mechan-2) Select Peds/Neo3) Fill up the blanks as showed below

HOW TO ORDER NCPAP (Nasal Continuous Positive airway pressure)(Pt with frequent apnea, intermittent desaturations)1) Under order entry, SELECT Mechan-2) Select Peds/Neo3) Fill up the blanks as showed below

HOW TO ORDER NCPAP /SIMV (Pt with frequent apnea, irregular respirations with intermittent desaturations, in between active)1) Under order entry, SELECT Mechan-2) Select Peds/Neo3) Fill up the blanks as showed below

HOW TO ORDER SIMV in the Bear cub ventilator. (Pt with frequent apnea, irregular respirations

with intermittent desaturations, Patient is intubated1) Under order entry, SELECT Mechan-2) Select Peds/Neo3) Fill up the blanks as showed below